ANN ARBOR, MI - Most of us don't think much about our voices from day to day, taking for granted our ability to talk, shout, murmur, laugh and groan. Many people - teachers, lawyers, clergy and salespeople, as well as actors, singers and radio hosts - rely on their voices to do their jobs.

But, says a University of Michigan expert, much can go wrong with the human voice. In fact, our voices can say a lot about our health - if we would only listen.

Changes in a person's voice can indicate anything from a common cold or acid reflux to throat cancer or vocal cord paralysis, says U-M vocal health specialist Norman D. Hogikyan, M.D. But many people don't know they can protect their voices by following a few simple tips, and should seek medical attention for prolonged voice changes.

This week, Hogikyan and his fellow specialists around the world hope to raise the public's awareness of voice-related issues. They've declared Wednesday, April 16, as World Voice Day, through voice societies in South America, Europe and the professional society for ear, nose and throat physicians in the United States: the American Academy of Otolaryngology - Head and Neck Surgery.

To help people understand how to protect their voices and recognize problems, Hogikyan and his colleagues prepared four fact sheets and an online Voice Quiz for the academy's web site, www.entnet.org/news/voiceday.cfm. (A sample of the tips follows below.) The quiz helps visitors identify how voice-related problems are affecting their lives; it's based on U-M research on voice-related quality of life.

"Thankfully, most voice changes are temporary and self-limiting, but if they last longer than a few weeks, they can signal serious problems," says Hogikyan, who runs the U-M Vocal Health Center at the U-M Health System's Center for Specialty Care in Livonia, Michigan. "Early attention to voice changes can literally make the difference between life and death for throat cancer patients, and in other cases can help resolve more minor issues before serious ones develop."

If throat cancer is caught early, the likelihood of a cure without extensive treatment is very good, says Hogikyan, an associate professor in the U-M Medical School's Department of Otolaryngology - Head and Neck Surgery. But those whose cancer is caught later will usually need more extensive treatment, possibly including removal of the voice box, and the chance of a cure is significantly decreased.

"Even for those without vocal problems, you should take care of your voice and remember that it's your natural instrument," Hogikyan says. He advises drinking plenty of water, avoiding abusive behaviors such as screaming or shouting, and not smoking. Special care of the voice is even more crucial for occupational or professional voice users, who place high demands on their voices.

And those who want to learn more about how the voice works might be interested in a new video, "The Living Voice: A Guided Tour of the Human Larynx in Speech and Song", made by Hogikyan and Freda Herseth, an associate professor of vocal arts in the U-M School of Music. It includes video of the human voice box, or larynx, in action, as captured by a camera-equipped throat scope. It's an engaging and sometimes humorous video for music teachers and other educators of students from grade school through college, as well as those who use their voices professionally or care for people with voice disorders. For more information, e-mail livingvoice@umich.edu.

The U-M Vocal Health Center, is at www.med.umich.edu/oto/vocalhealthcenter/ or 734-432-7666.

Tips for maintaining a healthy voice:

• Drink water to keep your body well hydrated, and avoid alcohol and caffeine. Your vocal cords vibrate very fast, and having a proper water balance helps keep them lubricated.
  
• Don't smoke, or if you already do, quit. Smoking raises the risk of throat cancer tremendously, and inhaling smoke (even secondhand smoke!) can irritate the vocal cords.
  
• Don't abuse or misuse your voice. Avoid yelling or screaming habitually, and try not to talk loudly in noisy areas. If your throat feels dry or tired, or your voice is getting hoarse, stop talking. And don't alter your voice to speak in a higher or lower pitch than normal.
  
• Don't clear your throat too often. When you clear your throat, it's like slamming your vocal cords together. Doing it too much can injure them and make you hoarse. Try a sip of water or swallow. If you feel like you have to clear your throat a lot, get checked by a doctor for reflux disease, or allergy and sinus conditions.
  
• When you're sick, spare your voice. Don't talk when you're hoarse due to a cold or infection. Listen to what your voice is telling you!

Common causes of voice changes:

• Common cold or upper respiratory infection, laryngitis
  
• Voice overuse
  
• Vocal cord lesions such as nodules or polyps
  
• Gastroesophageal and laryngopharyngeal reflux disease (caused by acid from the stomach)
  
• Poor speaking technique
  
• Vocal cord paralysis
  
• Throat cancer

If your voice does not return to its normal characteristics and capabilities within three to four weeks, a medical evaluation by an ear, nose, and throat specialist is recommended. This is especially true for smokers or heavy drinkers, who are at high risk for throat cancer.

How to recognize a voice problem:
Voice problems usually are associated with hoarseness (roughness), instability, or problems with voice endurance. If you're not sure if you have an unhealthy voice, ask yourself the following:

• Has your voice become hoarse or raspy?
  
• Does your throat often feel raw, achy or strained?
  
• Has it become an effort to talk?
  
• Do you repeatedly clear your throat?
  
• Do people regularly ask you if you have a cold when in fact you do not?
  
• Have you lost your ability to hit some high notes when singing

If the answer to any of these is "yes", ask your doctor about seeing a voice specialist.

Written by: Kara Gavin

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